SUSPECT INFORMATION LEAVE BLANK

TYPE OR PRINT ALL INFORMATION IN BLACK LAST NAME NAM FIRST NAME MIDDLE NAME

FBI LEAVE BLANK

STATE USAGE

ALIASES

CONTRIBUTOR

DATE OF BIRTH DOB MONTH DAY YEAR

SIGNATURE OF PERSON FINGERPRINTED

NCO92013Y CITY-CO BOF I RALEIGH, NC

PLACE OF BIRTH POB

THIS DATA MAY BE COMPUTERIZED IN LOCAL STATE AND NATIONAL FILES

DATE ARRESTED OR RECEIVED DOA

SEX

RACE

HGT

WGT

EYES

HAIR

DATE

SIGNATURE OF PERSON TAKING PRINTS

YOUR NUMBER, OCA

LEAVE BLANK CLASS _______________________________________

CHARGE

FBI NO. FBI

REF. _______________________________________

SID NO. SID

NCIC CLASS-FPC

FINAL DISPOSITION

SOCIAL SECURITY NO. SOC

IF ARREST FINGERPRINTS SENT FBI PREVIOUSLY AND FBI NO. UNKNOWN, FURNISH ARREST NO. ________________ AND DATE _______________

PERSONAL ITEMS ACQUIRED 1. Pen Type: ____________________________________________________

PALM PRINTS TAKEN YES _________ NO __________ PHOTO AVAILABLE YES _________ NO __________

2. Plastic Code: __________________________________________________ 3. White Powder ID: ______________________________________________

ARREST DISPOSITIONS AND

RESIDENCE OF PERSON FINGERPRINTED

EMPLOYER: IF U.S. GOVERNMENT INDICATE SPECIFIC AGENCY IF MILITARY, LIST BRANCH OF SERVICE AND SERIAL NO.

SCARS, MARKS, TATTOOS AND AMPUTATIONS, SMT

OCCUPATION

DATE OF OFFENSE DOO

BASIS FOR CAUTION ICO

REPLY DESIRED? YES _______ NO ________

SKIN TONE SKN

MISC. NO MNU

IMMEDIATE REPLY DESIRED? YES _______ NO ________ WILL ACCEPT COLLECT CALL OR WIRE? YES _____ NO ______ TELEPHONE OR WIRE NUMBER: ____________________________

SEND COPY TO NAME, ORI NUMBER AND ADDRESS:

1. R. THUMB

2. R. INDEX

3. R. MIDDLE

4. R. RING

5. R. LITTLE

1. L. THUMB

2. L. INDEX

3. L. MIDDLE

4. L. RING

5. L LITTLE